Hi again everyone,
My latest query is something I feel rather shocked about but an off the mark comment made by somebody in the community assessment team implied that various processes in my mother’s continuing health care and social care assessment had been completed without keeping me informed.
On later enquiries I was told that a continuing health care checklist was considered and my mum was found ineligible and this decision was made by the nursing home team and somebody from the continuing healthcare team. Then, that her case had been passed over to the social services for social care assessment and the assessor is to take my mum’s case to a panel next week recommending funding.
I haven’t been kept informed or consulted about any of this and it feels as though decisions are being made in the best interests of CHC and social services. Nothing was mentioned in the email from the social services assessor about what I have been stressing all along which is mum’s move to Manchester.
Is this all normal or can I insist on involvement and more information being provided?
Thanks for any input and thoughts
Have a look at the CHC Framework.
I would make a formal complaint that the assessment was unlawful and therefore should be repeated.
When mum had her assessment, I insisted on being present, and went with copies of a written agenda detailing all the things I wanted discussed. Met with stunned silence. No one had ever done that before!
Every time they started using jargon to try and exclude me, I asked them not to do that, it was inappropriate when a member of the public was involved in a meeting. Every single time I stopped them. Great fun really, made them look so stupid!
I would also complain to the CEO of the hospital, that proper procedures were not being followed.
Does mum have over £23,000 in savings, or own a house? This is usually the cut off point for SSD care.
Have SSD been in touch with you now?
Have you been given a copy of the negative checklist? If not, ask for one!
No I haven’t been given anything and only discovered almost by accident that there had been an outcome of the CHC assessment when somebody mentioned in passing that mum’s case had been passed to the council. So yes willl be studying the framework in detail today and responding to the emails from both the community assessment team and the assessor for social care not having consulted me at all. I’ve also been sent a range of help sheets from Age UK after I called them last week but just wanted to check that I have not been over-reacting and being shocked that I haven’t been contacted and consulted at all!
I may run into difficulties, I realise, as I don’t have power of attorney and in being recognised as my mum’s representative but I will cross that bridge when I come to it.
Elizabeth, social care prefer someone to get CHC funding as then the cost of care comes out of the NHS pot instead of the social care one. Was the social worker involved?
Not having POA increases the challenge but at a best interests meeting family etc who know the person well should be included.
Thanks Melly. I made contact with the social worker last week and they said that an assessor had been allocated. I presumed this to be for CHC and social care, but now realise that at that point CHC had been ruled out as the community assessment person told me that my mum was referred to a social care assessment was made on July 13th.
If I was a cynical person I would be suggesting that CHC and social care are trying to meet the deadlines for their funding by CCG for the assessment bed which was for four weeks and expires next week!
I will research the framework and the care act and contact the community assessment person, the social worker, and the assessor and maybe the care home manager as well who should also have kept me informed as the community assessment person has stated that this checklist consideration was made between them and the care home.
I have to say that I am feeling quite staggered by all of this.
We were in a similar situation with our Mum’s placement (at the behest of the CCG) trying to exclude us from the checklist. Below is the relevant paragraphs from a letter I ha to send. I hope these are useful to you:
I very much take issue with your comment “The CHC checklist is done by the professionals and the outcome will be sent to the patient and family”. This is not true, and it is certainly not what was agreed at the last meeting where it was noted X(name removed) would require strong support and one of the family would also be able to be present to advocate and be involved on X’s behalf.
Whilst it is clear that “the checklist can be completed by a variety of health and social care practitioners, who have been trained in its use” (paragraph 92, NF NHS CHC), you will note from that the “Core Value and Principles” Section of the NF NHS CHC, which applies to the assessment “process” as a whole, states:
- “The process of assessment of eligibility and decision-making should be person-centred. This means placing the individual at the heart of the assessment and care-planning process” (Paragraph 67).
- This includes, inter alia, “ensuring that the individual and/or their representative is fully and directly involved in the assessment process” and “keeping the individual (and/or their representative) fully informed” (Paragraph 68).
- “Assessments of eligibility for NHS Continuing Healthcare and NHS-funded Nursing Care should be organised so that the individual being assessed and their representative understand the process and receive advice and information that will maximise their ability to participate in the process in an informed way” (Paragraph 70).
In the NF NHS CHC the term representative is intended to include any friend, unpaid carer or family member who is supporting the individual in the process as well as anyone acting in a more formal capacity.
In terms of the checklist screening process specifically, it is stated at paragraph 94 that “The individual should be given reasonable notice of the intention to undertake the Checklist, and should normally be given the opportunity to be present at the completion of the Checklist, together with any representative they may have”. This is absolutely key to if and when the checklist should be carried out. We also note “It is essential that the appropriate consent is sought prior to commencing this process” (paragraph 82) this specifically relates to the checklist.
For the avoidance of doubt, we were working on the basis that everyone was aligned on the way forwards from the last meeting; i.e. Y would seek to arrange a direct assessment with the CCG, and before this took place every specialism would complete a written assessment of X’s needs and these would be discussed two weeks from the date of the last meeting and before any CHC assessment processes, and a family member would be present with X for any CHC assessment processes. If this is no longer the plan, then there is no family agreement, and the next step would be a best interests meeting. I would hope given the conclusive guidance in the framework this would not be necessary.
One of the main reasons why a family representative is required with X at any type of assessment is the history and complexities of her needs. We are particularly conscious of the enshrined principle that “well managed needs are still needs” and therefore her history and experiences prior to (the placement) are very relevant (paragraphs 142-146).
I would also complete your own Checkist for your Mum and bring this to any future meeting and then argue as to why they do not think needs you have put down on your version are at the correct level.
This is very useful indeed and I will use the elements you refer to from the framework to challenge what appeared to be a comment in passing from the community assessment team member and the local council’s social care assessor and yes will also complete my own checklist. Thanks so much for this help.
CHC is much more important if someone has over the threshold of SSD care, i.e. the £23,000 I mentioned earlier.
If not, then SSD will have to contribute to some or all of her care.
I am not sure what SSD care is but yes my mum is below that threshold.
Apologies, Social Services Department. In that case, don’t worry too much about Continuing Healthcare. Get the local Social Services to do their assessment asap. Authorities have a reciprocal arrangement. Normally they are required to honour the assessment of the previous authority until they have done their own. It’s in the Care Act Guidance somewhere.
This is probably what you need to read.
Ah OK. I understood that if we get CHC then the full cost of care can be funded whereas if it is social care funded only part may be funded, depending on the personal budget.
The social care assessor said he is going to submit an application to a panel for nursing care next week, so maybe that might be good enough? I have sent some strongly worded emails today so we will see what happens with those and with the social care assessment.
I do hope that something can happen soon and my mother can be transferred up here soon. Thanks for your help.
Yes, but since mum has limited savings, Social Services will take most of mum’s pension, and leave her with £25 approximately from her pension and pay a share of the rest of her fees anyhow. Financial assessments are based entirely on the client’s assets. Maybe contact the local council about vacancies and financial assessments asap? Hampshire has a page where vacancies are updated daily.
CHC is totally free care. If someone owns a property, then the value of that property is considered by Social Services, but with CHC, income, savings, and property are not assessed as it’s part of the NHS Free care. As mum doesn’t have a property, I’d just concentrate on finding someone you like near you. However, you will need to check with the home first that they accept Social Services funded patients.
This then leaves the question of getting her there. Start by contacting your local ambulance service. They may not do it themselves, but if that is the case, they will be able to tell you who can help. Since mum is going to have a financial assessment, the cost of this is almost irrelevant, because if her savings go down because of the cost of the ambulance, she will pay less.
Thanks Bowlingbun, there clearly is a lot to consider. I am taking it one step at a time but yes I had appreciated the financial impacts of CHC and social care.
I have had some success this morning. Apologies sent for not consulting me about the checklist assessment, plus a copy of the assessment received. I have challenged the assessment of some of the domains and again the person was very willing to take my points on board and a review of the assessment is now going to be undertaken.
So some encouraging developments this morning.
Well done. It’s all so stressful.
Yes it is but this feels like a small win so a good day.
That sounds like a really positive step forward… whether an assessor has an accommodating mindset or not has a big impact on the effort and stress involved!
Yes I think so William and even if a complete assessment is not undertaken I feel reassured that my mother’s needs will be reassessed in some way (perhaps by social services) and that I will be consulted more about her needs. So I am feeling hopeful this evening.